Why using PREVIEW-ED© is Important
Many Emergency Department visits by residents of facilities focused on care of the elderly are potentially preventable if caught in the early stages.
PREVIEW-ED focuses on four conditions: Urinary Tract Infections, Pneumonia, Congestive Heart Failure and Dehydration. These conditions account for approximately 50% of the reasons for transfer of LTC residents to the Emergency Department (ED).
The proportion of seniors aged sixty-five and older is growing faster than any other age group. By 2031 Canadian seniors will account for 22.8% of the population. 1 In 2013-2014, one in three seniors in LTC visited the ED. Of these visits, 24% were for potentially preventable conditions. Pneumonia and UTI accounted for 56% of these visits.2 Studies of the elderly admitted to hospital report 22.9% to 43.9% experience one or more iatrogenic illness with potential for serious or fatal complications. 3
Among the most frequently occurring hospital-acquired illnesses in the elderly are delirium, pressure ulcers, falls and dehydration. These conditions not only adversely impact the quality of life of the frail elderly but are also costly. In a 2011 Canadian study, the prevalence of hospital-acquired pressure ulcers for the elderly admitted through ED was 19.6%. Complications related to pressure ulcers may include infection at the ulcer site and potentially, sepsis. Based on 2011 dollars, the study projected that the prevention of ED- acquired pressure ulcers would save Ontario $7.2 million in hospital costs per year. 4
The current LTC population is older, frailer, and sicker, has multiple co-morbidities, complex histories, cognitive impairment or dementia, and limited ability to compensate for critical illness. Limitations in vision, hearing, and cognition alter their ability to communicate symptoms, medical history, or basic personal information. 1
1. Canadian Institute for Health Information, November 2014. Sources of potentially avoidable emergency department visits. https://www.cihi.ca. Accessed November 30, 2014.
2. Canadian Institute for Health Information, Infosheet. https://secure.cihi.ca/free_products/NACRS_ED_QuickStats_Infosheet_2013-14_ENweb.pdf. Updated 2014. Accessed October 10, 2017.
3. Jensen PM, Fraser F, Shankardass K, Epstein R, Khera J. Are long-term care residents referred appropriately to hospital emergency departments? Can Fam Physician. 2009;55(5):500-505.
4. Pham B, Teague L, Mahoney J, et al. Early prevention of pressure ulcers among elderly patients admitted through emergency departments: A cost-effectiveness analysis. Ann Emerg Med. 2011;58(5):468-478. e3.
Who PREVIEW-ED© Helps?
Currently the focus has been on LTC residents. However, Home Care, Rehabilitation, specialized LTC units such as Ventilator units, Complex Continuing Care, and Assisted Living Facilities have expressed interest in using PREVIEW-ED. In addition, family members caring for aging parents in the home have also been testing PREVIEW-ED.
In addition to these sectors, avoiding ED transfers is also helpful to acute care facilities in terms of demand on both the Emergency Department and the impact on bed flow.
Improving quality of care is one of the top priorities in all sectors of healthcare. Appropriate use of healthcare funding dollars is also a key deliverable for healthcare leaders. PREVIEW-ED accomplishes both. It helps maintain quality of life for residents of LTC and it avoids the unnecessary costs of transportation, ED visit and potential admission to acute care.
As of March 2017, 79 LTC facilities (8063 LTC beds) in Fraser Health Authority in British Columbia have implemented PREVIEW-ED as well as one Ontario LTC facility.